This invention relates to arthroscopic surgical procedures and, more particularly, to an improved procedure to perform trigger finger release and trigger thumb release.
Trigger finger or trigger thumb is a condition which typically effects the middle aged. It manifests itself as an involuntary movement of a finger or thumb in response to a sensed pressure in the palm of the hand. Although the condition may be congenital, it is seldom found in children over the age of two. If combined with a collagen disease which attacks the connective tissue in the hand, several fingers of a person's hand may be involved. The condition most often effects the middle finger or ring finger; although, as the name implies, the thumb is also often involved. If a nodule is formed, or a fusiform (spindle-like) swelling occurs, a restriction, or narrowing, or stenosis of the flexor tendon results. This narrowing occurs adjacent the sheath or theca covering the tendon at the distal crease in the palm of the hand. The nodule usually appears at the point where the tendon enters the proximal annulus at the level of the metacarpophalangeal joint. Applying pressure to the nodule, such as by palpatating it, causes the nodule to move with the tendon. If the thumb is involved, the interphalangeal joint will be the one that appears to snap or lock, even though the constriction is, as noted, associated with the metacarpophangeal joint.
Sectioning of the annulus through a surgical procedure may relieve the triggering. In some instances, a partially lacerated flexor tendon will heal with a nodule large enough that there may be a recurrence of the triggering. Or, if the patient is rheumatoid, there may be complications. However, the problem is one which lends itself to a surgical solution. One problem with current surgical techniques is that they require a lengthy incision to be made in the palm of the hand to facilitate insertion of a surgical knife or scissors used to cut the sheath surrounding the flexor tendon and relieve the constriction. Once the knife or scissors is removed, stitches are required to close the wound. This results in scarring. Arthroscopic surgical apparatus for releasing trigger finger is described in my co-pending U.S. patent application Ser. No. 07/135,462, filed Dec. 10, 1993.